A case of hepatocellular carcinoma with a huge portal-systemic shunt via the inferior mesenteric vein and liver cirrhosis

We reported a resected case of hepatocellular carcinoma (HCC) with a huge portal-systemic shunt via the inferior mesenteric vein (IMV) and liver cirrhosis. Laboratory data showed the disturbance of liver function. However the patient has had no hepatic encephalopathy and gastro-intestinal bleeding. The percutaneous tanshepatic portography revealed the backflow to inferior vena cava via IMV. Thereafter we performed hepatectomy for HCC without ligation of IMV after the measurement of portal blood flow by ultrasonic transient flowmeter. Postoperative clinical course was good without the appearance of hepatic encephalopathy and esophageal varices. As a result, ligation of the huge shunt is not indicated if the patient has diffuse liver disease without hepatic encephalopathy and gastro-intestinal bleeding, because the other collateral pathways may be getting worse by the ligation of the shunt.